Problem severity profiles of substance abusing women in European Therapeutic Communities: Influence of psychiatric problems

Women’s treatment on men’s conditions: a critical evaluation of selected literature and research findings

Purpose

Deviant behavior was punished during the middle ages. In the seventeenth century, people were locked up in asylums. A first step towards humanization was taken by the founders of the moral treatment movement in the nineteenth century, but it declined at the end of that century. What we today call “milieu therapy” represents a new phase in treating mental illness and deviance. After the Second World War, the therapeutic community (TC) method was widely implemented in Europe, but the needs of different target populations were not dealt with equally. The paper aims to discuss these issues.

Design/methodology/approach

In this contribution, the treatment needs of diverse populations of female drug abusers are addressed. Selected literature and research findings for women in mixed and gender-specific treatment are presented.

Findings

The conclusion is that we need a women and family perspective in substance abuse treatment and research. Moreover, a holistic and multidisciplinary treatment approach is needed since so many factors and aspects are involved.

Originality/value

Treatment programs should focus on long-term lifestyle changes and be tailored to the specific needs of diverse target populations. Modified TCs for women and men with children and/or dual diagnosis are definitely the future for TCs.

Socio-demographic characteristics and consumption patterns of drug users – synthesis of outcome research at a TC for a 10 year range

Purpose

– Therapeutic communities (TCs) are one of the existent social responses in helping drug users overcome addiction and pursue social reintegration. The purpose of this paper is to present and discuss the general characteristics of about 200 drug users and their addiction and those of addicts abroad treated in a TC and clinically discharged. The analysis now presented is the first empirical approach to capture social regularities and singularities that are present in these individuals’ reintegration strategies.

Design/methodology/approach

– The data have a ten-year range – from 1999 to 2009 – and were statically analysed.

Findings

– They show a group of individuals with low qualifications reflected in their professional occupation, from which family is an essential support. These data also show a significant prevalence of heroin, alcohol, cocaine and polydrug uses, highlighting the need to consider new use patterns and new synthetic substances.

Originality/value

– TC have been little studied, mainly in Portugal.

Sex differences in opioid analgesia and addiction: interactions among opioid receptors and estrogen receptors

Opioids are widely used as the pain reliever and also notorious for being addictive drugs. Sex differences in the opioid analgesia and addiction have been reported and investigated in human subjects and animal models. Yet, the molecular mechanism underlying the differences between males and females is still unclear. Here, we reviewed the literature describing the sex differences in analgesic responses and addiction liabilities to clinically relevant opioids. The reported interactions among opioids, estrogens, opioid receptors, and estrogen receptors are also evaluated. We postulate that the sex differences partly originated from the crosstalk among the estrogen and opioid receptors when stimulated by the exogenous opioids, possibly through common secondary messengers and the downstream gene transcriptional regulators.

Differential substance abuse patterns distribute according to gender in heroin addicts

This study attempts to analyse potential gender differences among a group of heroin addicts seeking treatment at a university-based medical centre. The central modality of treatment at this centre is the use of methadone maintenance. Among those patients entering this program there seems to be an emerging pattern of males who tend to use heroin as their opiate of choice, and are more likely to combine it with cannabis, while females are more likely to use to street methadone, with adjunctive use of ketamine, benzodiazepines, hypnotic drugs and/or amphetamines. Women are at higher risk of abusing opioids through a pathway of initial prescription painkiller use, and later to resort to street methadone to cope with prescription pain killer addiction. This latter pattern seems to result in an increased risk for fatal accidental overdoses. The use of these longer-acting agents in women may be influenced by psychosocial and hormonal factors.

The role of gender differences and other client characteristics in the prevalence of DSM-IV affective disorders among a European therapeutic community population

There is a lack of research illustrating the extent of psychiatric problems in European TCs. Furthermore, there is a need to obtain more insight into gender differences concerning comorbidity in the TC population. In an attempt to respond to previous shortcomings, three specific goals were formulated for the current study. The primary aim was to explore the lifetime prevalence of affective disorders in European TC clients. The second aim was to focus on related gender differences. And finally, client characteristics measured by the EuropASI were related to mood and anxiety disorders measured by the SCID-I. Nine out of ten substance abusers treated in a European TC program have an affective disorder. Gender differences are noted for two anxiety disorders: men have more obsessive-compulsive disorders; women have more post-traumatic stress disorders. The study illustrates that not only gender but also other client characteristics should be taken into account when organizing treatment.

Motivation and readiness for therapeutic community treatment: psychometric evaluation of the Dutch translation of the Circumstances, Motivation, Readiness, and Suitability scales

There is empirical evidence that treatment motivation and readiness are closely linked to retention. Several instruments have been developed to measure these concepts; such instruments can reliably assess the stages of motivation and readiness, and predict treatment retention and outcome. However, limited efforts have been undertaken in Europe to translate those instruments and to determine their reliability and validity. In this study, the psychometric properties of a Dutch translation of the Circumstances, Motivation, Readiness, and Suitability (CMRS) scales by De Leon and Jainchill and the shortened CMR Intake Version are illustrated in a Flemish sample of therapeutic community residents (n = 207). Exploratory factor analyses confirm three CMR subscales, although confirmatory factor analysis reveals only a moderate fit for both the CMRS and the CMR. In contrast, the predictive power of the instrument is strong, specifically for 1-year retention. Significant correlations were found between CMRS measures and age, drug severity, legal referral, and social problems. It is concluded that the Dutch translation of the CMRS and the CMR can be employed as a valid indicator of treatment motivation and readiness, although additional research concerning factorial structures is needed.

Problem severity profiles of clients in European therapeutic communities: gender differences in various areas of functioning

The BIOMED II 'Improving Psychiatric Treatment in Residential Programmes for Emerging Dependency Groups' project provided a relatively large sample (n = 863) of men (77%) and women (23%) in therapeutic community treatment in nine European countries. This paper's aim is to search for gender differences in profiles of therapeutic community clients on the basis of the different areas of functioning of the EuropASI. A binary logistic regression model was used to avoid the confounding effects of country and age. Our findings confirm what is found in the American literature: compared to men, women have a much worse profile in various areas of functioning when entering treatment. In response, they may require a gender-adapted set of therapeutic interventions at the moment they enter treatment.